Intestinal Ischaemia

Question 1

Definition

Answer 1

Obstruction of a mesenteric vessel leading to bowel ischaemia and necrosis

Question 2

Aetiology

Answer 2

• Embolus (60%)
• Thrombosis (40%)

• Can be a consequence of:
o Volvulus
o Intussusception
o Bowel strangulation
o Failed surgical resection

Question 3

Risk factors

Answer 3

o AF
o Endocarditis (can throw emboli)

o Arterial Thrombosis: hypercholesterolaemia, hypertension, diabetes mellitus,
smoking

o Venous Thrombosis: portal hypertension, splenectomy, septic thrombophlebitis,
OCP, thrombophilia

Question 4

Epidemiology

Answer 4

• UNCOMMON

* More common in the ELDERLY

Question 5

Presenting symptoms

Answer 5

• Severe acute colicky abdominal pain
• Vomiting
• Rectal bleeding

• History of chronic mesenteric artery insufficiency
o Gross weight loss
o Post-prandial abdominal pain

• History of heart or liver disease

Question 6

Signs on physical examination

Answer 6

• Diffuse abdominal tenderness
• Abdominal distension
• Tender palpable mass (ischaemic bowel)
• Bowel sounds may be absent
• Disproportionate degree of cardiovascular collapse

Question 7

Investigations

Answer 7

• Diagnosis based on clinical suspicion or after laparotomy
• AXR - thickening of small bowel folds and signs of obstruction

• Bloods
o ABG - lactic acidosis
o FBC
o U&Es
o LFTs
o Clotting
o Cross-match

• Mesenteric Angiography
o Only if stable

Question 8

Common areas

Answer 8

NOTE: the ‘watershed zone’ (the area between the supply of the superior and inferior
mesenteric arteries - near the splenic flexure) is most vulnerable to intestinal ischaemia